No one wakes up one day, and rationally considers the thought that restriction, bingeing or weight preoccupation could be a way of coping with the stresses of life. Rather, it is often a gradual drift into the illness, beginning with healthy eating or a well-intended dietary overhaul. But, beneath the fragile veneer of the eating disorder, with its seemingly endless habits and eating rituals, someone is feeling exceptionally hopeless and low. Dieting and the possibility of thinness have often originally offered some sense of promise and hope. Of course, this is short-lived as the illness spirals out of control, bringing with it a multitude of problems.

Telling someone to ‘just eat’ or ‘you look fine as you are’ will likely fall on deaf ears. Although the person suffering might logically know this to be a wise choice, emotionally it is a different story. Restricting food and being in control of eating, have quickly become temporary ways of achieving feelings of mastery and accomplishment, these being welcoming thoughts when the general self-esteem barometer is low. Feelings of guilt around eating also become quickly intolerable when the person tries to step away from their imposed regime. Restriction or binge eating can also temporarily numb emotional pain and simplify life, stripped back to the most basic decisions around numbers of kilograms or calories. When real life is painful, this one dimensional existence can bring comfort and solace. People sometimes describe it as protective wall which they are reluctant to break down.

It can be difficult to express pain verbally. We can care too much about not hurting others, so keep quiet and hold our words inside. The eating disorder can offer a visible means of communication through loss of weight; disappearance of food or the inevitable depression and withdrawal that accompanies the illness. The person suffering did not intend or choose to communicate in this way, but it powerfully sends this message out to the world.

Tempting as it is to try and fix the problem with practical solutions of meal plans or daily weigh-ins, work hard not to adopt this approach (unless specifically asked by the sufferer). Initially, you need to look beneath the presenting issues and to recognise that someone is in pain. It is more helpful to be there as a friend or family member, to listen, to offer a safe space for someone to talk, not to judge or persuade. The sufferer might well need to seek professional help through specialist counselling; the earlier the intervention the better (ideally with them choosing to engage in this).

Active change is possible, when the sufferer themselves can acknowledge there is a problem. They can begin to understand why they are using the eating disorder to cope and begin to consider other self-caring ways of coping. This process cannot be rushed and will take time. Seek support for yourself as a carer if you are struggling to cope with the situation.